Topics in Geriatrics: Falls and Risk Factors for Falls
With the increase in population of older adults over the age of 65, the risk of falling has also increased. The purpose of this topic is to address who is falling, who is at risk of falling, and how physical therapists can address this issue.
Objectives:
The objectives of this page are to help:
1). Define a fall;
2). Understand how falls are impacting the United States as a whole;
3). Understand the causes of falls in the older adults;
4). Understand the risk factors for falls;
5). Understand the risk factors for injury from falls;
6). Learn about intervention techniques to decrease fall risks;
With the increase in the older adult population in the United States over the past decade and the expected continuous rise, it is important to address falls, one of the most common and significant health issues affecting this population (Schneider, 2010). What is a fall? The WHO defines a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.” 1 in 3 older adults over the age of 65 are at risk for falling, but, as they reach the age of 80, their risk increases to approximately 50% (Schneider, 2010). It is also important to note that, in North Carolina between the years of 2000 and 2009, the mortality rate increased by 60%, as did hospital and emergency room visits in the adult population of those 65 and older (Schneider, 2010).
Falls are also causing a financial burden on the health care system. In the past, falls accounted for roughly 6% of all medical expenditures in the older adult population. Early estimates indicated that the direct medical cost as a result of injuries from falls was approximately $19 million in the United States. With the rise in the population of adults 65 and older, the direct medical cost as a result of injuries from falls could exceed $54 billion by the year 2020 (Schneider, 2010)
There are number of reasons why older adults fall. A combination of 12 retrospective studies determined that accidental falling as a result of the environment is the number one reason why people fall. Researchers hypothesize that the environment creates conditions leading to a fall, which may be triggered by a slip or trip or by older adults being weaker, stiffer, less coordinated, and demonstrating abnormal gait patterns. Based upon this research, it is important to focus intervention strategies and education on internal risk factors and environmental strategies, due to the presenting intrinsic and extrinsic risk factors (Umpred, 2012)
There are wide arrays of fall risk factors. Risk factors for falls can be divided into intrinsic and extrinsic risk factors. Intrinsic risk factors relate to the individual, whereas extrinsic risk factors relate to the environment. Intrinsic risk factors include medical conditions (e.g., stroke and Parkinson’s Disease), poly pharmacy, impaired balance and gait, somatosensory, visual, or vestibular sensory loss, slower reaction times, lower extremity weakness and decreased ROM, cognitive deficits, depression, urinary urgency or incontinence, and footwear. Extrinsic factors include inadequate lighting or excessive glare, slippery or cluttered surfaces, lack of handrails or grab bars, attention distracters, and timing demands (Umpred, 2012).
Intrinsic and extrinsic risk factors also play a key role in determining risk of injury. Intrinsic factors that could negatively impact the individual and cause injury include low bone mineral density, low body mass, and impaired protective responses (automatic postural response). Extrinsic factors include falls that occur from a high height onto a hard surface. Therefore, it is important for the therapist to understand the mechanism of the fall during the assessment to determine the needs of the individual (Umpred, 2012).
The most important intervention to reduce the risk of falls is exercise. A meta-analysis of 44 studies determined that the minimum number of hours of exercise to reduce risk and rate of falling was 50. Balance activities that are of moderate to high intensity had the best outcomes, with a 25% reduction in falls. To have the greatest effect on balance training, the researchers suggest that the balance activities should be performed while standing, with little to no upper extremity support, and should become increasingly challenging throughout the course of the intervention. The meta-analysis also looked at the effects of strength training, stretching, and walking, but these types of intervention did not show a reduction in falls (Shubert, 2011).
National Center for Injury Prevention and Control. Preventing Falls: A Guide to Implementing Effective Community-based Fall Prevention Programs. 2nd ed. Atlanta, GA: Centers for Disease Control and Prevention, 2015.
Umpred, Darcy A., Rolando T. Lazaro, and Margaret :. Roller. Umphred's Neurological Rehabilitation. 6th. St. Louis , MO: Elsevier Health Sciences, 2012. Print.
Rubenstein, Laurence Z. "Falls in older people: epidemiology, risk factors and strategies for prevention." Age and AgeingOxford Journal 35.S2 (2006): 37-41. Print.
Schneider, Ellen C., Tiffany E. Schubert, and Katherine J. Harmon. "Addressing the Escalating Public Health Issue of Falls Among Older Adults." NC Medical Journal 71.6 (2010): 547-552. Print.
Shubert, Tiffany E. "Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of Literature." Journal of Geriatric Physical Therapy 34.3 (2011): 100-108. Print.
Stevens JA, Burns ER. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 3rd ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2015.
Umpred, Darcy A., Rolando T. Lazaro, and Margaret :. Roller. Umphred's Neurological Rehabilitation. 6th. St. Louis , MO: Elsevier Health Sciences, 2012. Print.
With the increase in population of older adults over the age of 65, the risk of falling has also increased. The purpose of this topic is to address who is falling, who is at risk of falling, and how physical therapists can address this issue.
Objectives:
The objectives of this page are to help:
1). Define a fall;
2). Understand how falls are impacting the United States as a whole;
3). Understand the causes of falls in the older adults;
4). Understand the risk factors for falls;
5). Understand the risk factors for injury from falls;
6). Learn about intervention techniques to decrease fall risks;
With the increase in the older adult population in the United States over the past decade and the expected continuous rise, it is important to address falls, one of the most common and significant health issues affecting this population (Schneider, 2010). What is a fall? The WHO defines a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.” 1 in 3 older adults over the age of 65 are at risk for falling, but, as they reach the age of 80, their risk increases to approximately 50% (Schneider, 2010). It is also important to note that, in North Carolina between the years of 2000 and 2009, the mortality rate increased by 60%, as did hospital and emergency room visits in the adult population of those 65 and older (Schneider, 2010).
Falls are also causing a financial burden on the health care system. In the past, falls accounted for roughly 6% of all medical expenditures in the older adult population. Early estimates indicated that the direct medical cost as a result of injuries from falls was approximately $19 million in the United States. With the rise in the population of adults 65 and older, the direct medical cost as a result of injuries from falls could exceed $54 billion by the year 2020 (Schneider, 2010)
There are number of reasons why older adults fall. A combination of 12 retrospective studies determined that accidental falling as a result of the environment is the number one reason why people fall. Researchers hypothesize that the environment creates conditions leading to a fall, which may be triggered by a slip or trip or by older adults being weaker, stiffer, less coordinated, and demonstrating abnormal gait patterns. Based upon this research, it is important to focus intervention strategies and education on internal risk factors and environmental strategies, due to the presenting intrinsic and extrinsic risk factors (Umpred, 2012)
There are wide arrays of fall risk factors. Risk factors for falls can be divided into intrinsic and extrinsic risk factors. Intrinsic risk factors relate to the individual, whereas extrinsic risk factors relate to the environment. Intrinsic risk factors include medical conditions (e.g., stroke and Parkinson’s Disease), poly pharmacy, impaired balance and gait, somatosensory, visual, or vestibular sensory loss, slower reaction times, lower extremity weakness and decreased ROM, cognitive deficits, depression, urinary urgency or incontinence, and footwear. Extrinsic factors include inadequate lighting or excessive glare, slippery or cluttered surfaces, lack of handrails or grab bars, attention distracters, and timing demands (Umpred, 2012).
Intrinsic and extrinsic risk factors also play a key role in determining risk of injury. Intrinsic factors that could negatively impact the individual and cause injury include low bone mineral density, low body mass, and impaired protective responses (automatic postural response). Extrinsic factors include falls that occur from a high height onto a hard surface. Therefore, it is important for the therapist to understand the mechanism of the fall during the assessment to determine the needs of the individual (Umpred, 2012).
The most important intervention to reduce the risk of falls is exercise. A meta-analysis of 44 studies determined that the minimum number of hours of exercise to reduce risk and rate of falling was 50. Balance activities that are of moderate to high intensity had the best outcomes, with a 25% reduction in falls. To have the greatest effect on balance training, the researchers suggest that the balance activities should be performed while standing, with little to no upper extremity support, and should become increasingly challenging throughout the course of the intervention. The meta-analysis also looked at the effects of strength training, stretching, and walking, but these types of intervention did not show a reduction in falls (Shubert, 2011).
Additional Recourses from the CDC
Community-Based Fall Prevention Program
Check for Safety: A Home Fall Prevention Checklist for Older Adults
What You Can Do To Prevent Falls: Brochure
Effective Fall Interventions
Healthcare Provider Recourses
Algorithm for Fall Assessment
Fall Risk Check List
Preventing Falls Pocket Guide
Talking about Fall Prevention with your Patients
References:
Algorithm for Fall Risk Assessment & Interventions. Center for Disease Control and Prevention. Web. <http://www.cdc.gov/HomeandRecreationalSafety/pdf/steadi-2015.04/Algorithm_2015-04-a.pdf>.
Check for Safety: A Home Fall Prevention Checklist for Older Adults. Center for Disease Control and Prevention, 2014. Web. <http://www.cdc.gov/homeandrecreationalsafety/pdf/steadi 2015.04/Check_for_Safety_brochure-a.pdf>.
"Falls." World Health Organization. Oct. 2012. Web. 15 May 2015. <http://www.who.int/mediacentre/factsheets/fs344/en/>.
Fall Risk Checklist. Center for Disease Control and Prevention, 2015. Web. <http://www.cdc.gov/homeandrecreationalsafety/pdf/steadi-2015.04/Fall_Risk_Checklist-a.pdf>.
National Center for Injury Prevention and Control. Preventing Falls: A Guide to Implementing Effective Community-based Fall Prevention Programs. 2nd ed. Atlanta, GA: Centers for Disease Control and Prevention, 2015.
Preventing Falls in Older Patients Provider Pocket Guide. Center for Disease Control and Prevention, 2015. Web. <http://www.cdc.gov/HomeandRecreationalSafety/pdf/steadi-2015.04/Algorithm_2015-04-a.pdf>.
Umpred, Darcy A., Rolando T. Lazaro, and Margaret :. Roller. Umphred's Neurological Rehabilitation. 6th. St. Louis , MO: Elsevier Health Sciences, 2012. Print.
Rubenstein, Laurence Z. "Falls in older people: epidemiology, risk factors and strategies for prevention." Age and AgeingOxford Journal 35.S2 (2006): 37-41. Print.
Schneider, Ellen C., Tiffany E. Schubert, and Katherine J. Harmon. "Addressing the Escalating Public Health Issue of Falls Among Older Adults." NC Medical Journal 71.6 (2010): 547-552. Print.
Shubert, Tiffany E. "Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of Literature." Journal of Geriatric Physical Therapy 34.3 (2011): 100-108. Print.
Stevens JA, Burns ER. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 3rd ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2015.
Talking about Fall Prevention with Your Patients. Center for Disease Control and Prevention. Web. <http://www.cdc.gov/homeandrecreationalsafety/pdf/steadi-2015.04/Talking_about_Fall_Prevention_with_Your_Patients-a.pdf>.
Umpred, Darcy A., Rolando T. Lazaro, and Margaret :. Roller. Umphred's Neurological Rehabilitation. 6th. St. Louis , MO: Elsevier Health Sciences, 2012. Print.
What Can You Do To Prevent Falls. Center for Disease Control and Prevention. Web. <http://www.cdc.gov/HomeandRecreationalSafety/pubs/English/brochure_Eng_desktop-a.pdf>.